Antihypertensive Treatment Can Delay Cognition Decline in Middle-Aged and Older Chinese between 2011 and 2015: Results from the China Health and Retirement Longitudinal Study

Abstract

Background: Observational studies have compared non-hypertensive to hypertensive individuals to evaluate the impact of high blood pressure on cognition. Clinical trials have examined cognition outcomes in hypertensive patients receiving new vs standard treatments to assess the impact of better treatments on cognition. No studies to date have compared outcomes in hypertensive individuals with or without hypertensive treatment and non-hypertensive controls. Methods: We examined blood pressure change and antihypertensive treatment in a national sample of 10,958 participants aged 45 years and older followed every two years between 2011 and 2015 in the China Health and Retirement Longitudinal Study. Cognition was measured by a composite score (range: 0-21) of episodic memory and mental intactness. Findings: At baseline, the study included 1,907 hypertensive individuals who reported treatment, 1,925 who reported no treatment, and 7,126 non-hypertensive controls. Untreated hypertensive individuals show a larger cognition decline than controls without hypertension, especially when aged 65 or older (Cognition score change: -0.65, 95% CI: -0.97, -0.34). Patients on hypertensive treatment show less cognition decline than those reporting no treatment (Score difference: 0.56, 95% CI: 0.18, 0.94). Similar changes were seen among participants aged 55-64 years. The largest impact of hypertension on cognition decline was seen among participants with less than primary school education. This group also benefited the most from hypertension treatment. Little cognition decline over time was seen among participants younger than 55 years. Interpretation: Our findings suggest that antihypertensive treatment may be effective in preventing the cognition decline over time associated with this condition, especially in the older people or people with less education. Funding Statement: None. Declaration of Interests: The authors have no competing interests. Ethics Approval Statement: Not required.